Dr. Richard Whelan - CRS New York city

Fistula surgery

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Dr. Richard Whelan - CRS New York city

Postby AnaCat » 04 Sep 2016, 14:42

Hi all,

I decided to take my time with surgery. Let's be honest - this isn't something you want to mess up. After a few years of extensive research, I chose to pursue surgery with Dr. Richard L. Whelan, a colorectal surgeon consistently rated among the top 10 colorectal surgeons in NYC. He is brightly intelligent, warm, interested, experience, and beyond capable with an intelligent, warm, and caring staff, including one whip-smart and talented Nurse Practitioner, Katheryn Baxter.

Dr. Whelan's website: http://www.colorectalsurgerynyc.com

Offices located at 425 W 59th St (between 9th and 10th Avenues), Suite 7B, New York, NY

Dr. Whelan considers himself a conservative surgeon and presented me with a tiered approach to the surgery, which built a high level of trust between us. He explained the process to a level of deep understanding. No matter what, the fistula would be unroofed. Then, depending on what he found, he had options: if he didn't have to cut through a lot of muscle and was confident that control would not be sacrificed, he would perform a complete fistulotomy; if he got in there and there was a small amount of muscle to be disturbed, he could place a cutting seton; if muscle and control might possibly be compromised, seton loops would be placed and I would begin the 6-8 month process of letting my body naturally push the setons closer to the surface of the skin, slowly, slowly through the muscle. At all costs, retaining my control was paramount. As he says, you can live with a fistula. It's MUCH harder to live with incontinence.

Because of a family emergency, I had to put off the surgery for another year, but finally went in for a fistulotomy at Mt. Sinai West's Ambulatory Surgery Center in NYC on August 11th, 2016. Dr. Whelan assembled an incredible top-notch team. I was impressed at every step - from the incredible care I received at intake to the amazing and intelligent collaborative approach taken by the anesthesiology team, to the post-op care I received in recovery. I had every confidence going in that I would be taken care of and that my voice had been heard. It was clear that I was part of a TEAM EFFORT to solve my problem. This was in stark contrast to Dr. Hon offering to take care of it at his office, which I just can't see working, considering how serious the operation was.

I had a saddle block (a spinal) and went completely to sleep. When I woke up, I wasn't in much pain, but couldn't walk for a couple hours until the anesthesia wore off. I was also incontinent, due to the muscles being completely numb. After I was released, my boyfriend and I took a taxi home, but stopped at the drug store to pick up my prescriptions. While I was at the drug store, the pain began to kick in, but the ketarolac / Tordoral kept that in check. I was METICULOUS with my medicine and sitzbaths, meticulous with changing the gauze, but holy smokes. I never expected to feel pain like that. Once the Tordoral ran out, I was only taking ibuprofen (I'd taken the Percocet I was prescribed to a drop-off center because it makes me barf and you can't flush it down the toilet without poisoning the water supply). Anyhow, a day after the Tordoral ran out, I was sobbing in the night with such intense sharp pain that I couldn't get out of bed to get more medicine. I was alone and super scared. It turned out all that shocking pain was coming from a tiny tiny cut where the sutures had popped out (at the very end of the incision, closest to the rectum) which was being exacerbated by the seton loops poking in the wound. (I've since learned from Kathryn Baxter to pack the wound with gauze so nothing can poke it.)

My fistula was a horseshoe shape, which can take longer to heal because it can go very deep and it curves (lucky me!). But I feel like the healing process has been on point. Kathryn said I was doing a good job and that the wound was healing correctly, granulating from the bottom up. It's been just over three weeks now, since the surgery, and the wound is half the size that it was. It may sound silly, but take a few minutes each day to picture the wound healing from the bottom up and the setons slowly pushing their way out. I think it helps. Even if it doesn't help physically, it helps me mentally and makes me feel like I have a bit of control over the healing process.

My pain is much lower now, after three weeks of sitz baths, bidets, taking it easy, sitting on my left cheek or reclining on my hip, laying down when I need to... but now, instead of the incision aching or stinging, its the setons that cause my rectum to ache. It feels like a constant need to push because of the exacerbation of the setons. I consciously relax my muscles throughout the day to relieve the pressure, but if I have to carry grocery bags (AGH!!! OUCH!!!) or walk for more than 15 or 20 minutes (and in NYC, we walk A LOT), then I am paying for it later that night and have to lay down until the ibuprofen kicks in and the aching pain subsides.

Kathryn Baxter mentioned that you can ask for longer seton loops, which will let them clear the incision entirely. I was worried I'd catch them on something, but she says you can start long and, as the wound heals, have them tightened. If I was doing this again, I would have slightly longer loops put in. I think that would've helped with the pain.

I'm a writer and sit most of the time to write, which has made it hard to do my work. But I have to tell you, I'm in a better place than where I was at the worst of dealing with the anal fistula. It was a long tract and would surprise me with leaking a whole bunch of clear liquid and/or blood (if it had just reopened) and could catch me off guard. It also really really hurt when it was swollen. This doesn't hurt that much. And there's the mental benefit to knowing that it's hurting because it's healing, not because it's getting worse. That makes a difference.

So far, I've had two follow-ups with Kathryn Baxter. The office is very easy to work with, they make you feel like an important part of their day, which is nice considering how it's a little embarrassing to be constantly talking about your malfunctioning butt. I mean... seriously.

The best news? I'm healing. The best best news? I'M NOT INCONTINENT! I still have leakage along the setons, which is the purpose of setons. Yes, it sucks, but it is what it is. My incision is still seeping, but it's healing. And it's no longer the terrifying gash that looks like someone chopped my butt with an axe. It's just a cut now and it's HEALING. I hate the look of the setons - they're bright orange and tied with scratchy sutures. There are two, so if one falls out, we don't have to do another surgery to reinsert, but I still don't like them. For some reason, I imagined them being clear silicon bands. Oh, well. They're probably orange so it's easy for the doctor to see them. But in 6-8 months, I hope I'm not dating... because it's kind of tricky to explain why you have plastic loops coming out of your a**. Besides, my story is going to be that I was sailing and slid back on a cleat. That's why I have this rad scar... from SAILING! (ha ha... just kidding)

I can't recommend Dr. Whelan and his team highly enough. They're the real deal and they know what they're doing. They're also kind, brilliant, warm, and efficient - exactly the people you want when you're giving over your pooper to someone while you're knocked out. Frankly, the ONLY kind of people you want when you're giving over your pooper to someone while you're knocked out. So, bravely call them. You'll be glad you did.
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Re: Dr. Richard Whelan - CRS New York city

Postby pinpin » 01 Nov 2016, 06:04

Thank you for sharing this! I think many ppl will find it very useful, NYC is crazy big, and it is not easy to find reliable doctor.
07.02.2013 - got open hemorrhoidectomy, leaded to slow healing wound. Link to story
11.12.2013 - LIS surgery
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